The long-term effects of cocaine exposure during pregnancy and the effects of cocaine use on the child's environment are major public health concerns, but very little information exists regarding these effects. This proposal represents an opportunity to define the long-term effects of prenatal cocaine exposure with a large, well-established cohort of substance-using women and their offspring. This is a unique study of prenatal cocaine use in which trimester-specific information has been collected and the children have been assessed through age 7. The strengths of the study include exceptional follow-up rates, a detailed assessment of all substances, measurement of potential confounding variables, particularly environmental variables, and a comprehensive child assessment battery. We have found direct effects of prenatal cocaine exposure on the development of the central nervous system and on growth. At birth, we detected neurological and neurobehavioral effects on the EEG-sleep studies and the Brazelton NBAS, respectively. We found that prenatal cocaine exposure predicted delayed motor development at 1 year. At both 1 and 3 years of age, exposed children were reported by their mothers to be fussier and more difficult, a finding that was confirmed by independent observation in our testing situation. At 3 years, prenatal cocaine use significantly predicted decreased IQ scores, an increased number of behavior problems, and decreased head circumference. At age 7, the same domains were affected: Prenatal cocaine use predicted smaller head circumference, lower IQ and achievement test scores, and increased attention and behavior problems. A longitudinal analysis demonstrated a significant time by exposure interaction, revealing a significant decline in IQ scores between 3 and 7 years among the cocaine-exposed children. This is a proposal to assess the cohort at 10 years of age, when we can assess new and more complex dimensions of functioning. As the child matures, CNS development continues, and more cognitive demands are made. We will assess the child's cognitive, neuropsychological, behavioral, and physical characteristics using age-appropriate instruments that will allow us to explore the more subtle neuropsychological consequences of prenatal exposure. We will also carefully assess the mother's current substance use, sociodemographic, psychological, and environmental characteristics. The longitudinal design and careful attention to factors in the current environment allow a more detailed identification of the long-term effects of prenatal cocaine use. Our hypotheses are: (1 ) the effects of cocaine exposure on our moderately exposed sample will continue to be manifested as neurobehavioral and growth deficits (this follows from the teratologic model); and (2) deficits will be seen in the following domains: cognitive (learning and memory), behavior and attention problems, and mood.